Evidence-based approach to manage persistent wound-related pain

PURPOSE OF REVIEW: Pain is a significant concern in people with chronic wounds. A systematized approach is recommended for the management of wound-associated pain with the objectives to address pain relief, increase function, and restore overall quality of life. RECENT FINDINGS: Combinations of pharmacological agents are often recommended based on varying degree of pain severity, coexisting nociceptive and neuropathic pain, and chronic inflammation related to wound-associated pain. Topical agents including morphine, tricyclic antidepressants (e.g., amitriptyline), nonsteroidal anti-inflammatory drugs (NSAIDs), capsaicin, ketamine, and lidocaine/prilocaine provide pain relief with minimal side effects. Mindful dressing selection to minimize trauma, handle excess fluid, and prevent periwound skin damage has been shown to reduce persistent wound pain. To avoid nocebo hyperalgesia, it is important to address emotions, anticipation or negative expectation of discomfort. SUMMARY: Pain is a complex biopsychosocial phenomenon that requires multiple pharmacological and nonpharmacological management approach.